Table I.

Summary of recommendations for the use of neurophysiological tests in pelvic floor diseases.

Pelvic floor disease	Test	Method*	Anatomical pathway	Clinical usefulness	Recommendation
Cauda equina and conus medullaris lesions	CNEMG	Multi-MUP analysis of EAS1	Sacral alpha motor neurons, EAS	Useful for assessing collateral reinnervation occurring after axonal or neuronal sacral motor lesions	Grade B
	PNTML	St. Mark’s technique2	Pudendal nerve distal motor fibers	Undefined	Grade D
	Sacral reflexes	BCR3	Sacral reflex arc	Useful for assessing both peripheral branches of the sacral reflex arc and the conus medullaris	Grade B
		PUR4	Sacral reflex arc	Useful for assessing both peripheral branches of the sacral reflex arc and the conus medullaris	Grade C
	pSEPs	Pudendal nerve stimulation, cortical recording5	Pudendal sensory fibers, sacral spinal cord	Useful for assessing both pudendal afferent fibers and the sacral spinal cord	Grade B
	pSSR	Median nerve stimulation, perineal skin recording6	Post-ganglionic sympathetic fibers	Useful for demonstrating the integrity of the sympathetic pathway in cauda and conus lesions	Grade B
	pMEPs	Magnetic stimulation of the Lumbosacral roots7	Sacral roots, plexus and pudendal nerve motor fibers	Useful for assessing sacral motor neurons	Grade B
Peripheral neuropathies	Sacral reflexes	BCR3	Sacral reflex arc	Not useful for assessing sexual dysfunction in peripheral neuropathy	Grade B
	pSEPs	Pudendal nerve stimulation, cortical recording5	Pudendal nerve sensory fibers	Undefined	Grade D
	pSSR	Median nerve stimulation, perineal skin recording6	Post-ganglionic sympathetic fibers	Undefined	Grade D
Sacral plexopathy	PNTML	St. Mark’s technique2	Pudendal nerve distal motor fibers	Undefined	Grade D
	Sacral reflexes	BCR3	Peripheral branches of sacral reflex arc	Undefined	Grade D
	pSEPs	Pudendal nerve stimulation, cortical recording5	Sacral peripheral sensory fibers	Undefined	Grade D
Spinal cord lesions	CNEMG	Multi-MUP analysis of EAS1	Sacral alpha motor neurons	Clinical usefulness for assessing axonal damage due to anterograde trans-synaptic degeneration in suprasacral SCI	Grade D
	Sacral reflexes	BCR1, PUR4, PAR8	Sacral spinal cord	Not useful in suprasacral spinal cord lesions	Grade B
	pSEPs	Pudendal nerve stimulation, cortical recording5	Central somatosensory pathway from sacral region to the cortex	Useful for detecting central nervous system lesions	Grade B
	pSSR	Median nerve stimulation, perineal skin recording6	Sympathetic efferent fibers	Useful for assessing dysfunction of sympathetic fibers in lesions above TL level	Grade B
Parkinsonisms	pMEPs	Transcranial magnetic stimulation7	Central motor pathway from the cortex to sacral muscles	Undefined	Grade D
	CNEMG	Quantitative MUP analysis of EAS1	Sacral alpha motor neurons, EAS	Useful for assessing neurogenic changes in patients with clinical diagnosis of MSA Clinical usefulness in distinguishing MSA from IPD Not useful for distinguishing MSA from PSP	Grade B Grade D Grade B
	Sacral reflexes	BCR1, PAR8	Sacral spinal cord	Undefined	Grade D
	pSEPs	Pudendal nerve stimulation, cortical recording5	Somatosensory afferent volley	Undefined	Grade D
	pMEPs	Transcranial and lumbosacral magnetic stimulation7	Central and peripheral motor pathway from the cortex to sacral muscles	Undefined	Grade D

Abbreviations: BCR=bulbocavernosus reflex; CNEMG=concentric needle EMG; EAS=external anal sphincter; MUP=motor unit potential; pMEPs=perineal motor evoked potentials; PNTML=pudendal nerve terminal motor latency; pSEPs=pudendal nerve somatosensory evoked potentials; PAR=pudendal-anal reflex; PUR=pudendal-urethral reflex; pSSR=perineal sympathetic skin response.

^*References for methods: ¹ Podnar and Vodusek, 2001b; ² Swash and Snooks, 1986; ³ Podnar, 2008b, Podnar, 2014; ⁴ Awad et al., 1981, Blaivas et al., 1981; ⁵ Niu et al., 2010, Niu et al., 2015; ⁶ Tas et al., 2007; ⁷ Brostrøm, 2003; ⁸ Rodi et al., 1996b.